Objective: Critically ill children are vulnerable to a variety of negative behavioral, emotional, and academic outcomes. These children and their parents also are at risk for post-traumatic stress disorder (PTSD). Despite these outcomes, there has been a paucity of intervention studies designed to enhance outcomes in this population. Therefore, the objective of this study was to evaluate the short- and long-term effects of a theoretically-driven reproducible intervention program (COPE=Creating Opportunities for Parent Empowerment) on the psychological and functional coping outcomes of critically ill young children and their mothers, up to 12 months following hospitalization. Design: A multi-site randomized controlled trial was conducted in which critically ill children and their mothers were randomly assigned to either the experimental or control group at each of two study sites. Population, Sample, Setting, Years: The convenience sample was comprised of 174 mothers and their 2- to 7-year-old children who were unexpectedly admitted to the pediatric intensive care units of two children’s hospitals in Upstate New York and Pittsburgh, Pennsylvania from 1997-2000, with follow-up during 2000-2001. Mean length of time in the PICU averaged 63.9 hours and total length of hospital stay averaged 6.9 days. Intervention and Outcome Variables: The experimental intervention (COPE) was a three-phase educational/behavioral intervention, driven by self-regulation and control theories. COPE was comprised of: (a) audiotaped information about common childhood responses to critical illness and how mothers could enhance coping in their children, and (b) parent-child therapeutic activities (e.g., medical play and puppet play). The structurally equivalent control condition was comprised of audiotaped information about the hospital’s services and procedures and control parent-child activities (e.g., coloring). Maternal process and outcome variables included: parental beliefs about their critically ill children and role, negative mood state, state anxiety, stress related to the PICU, participation in their children’s care, parental role change, and PTSD symptoms. Child outcomes included measures of child adjustment, including internalizing and externalizing behaviors, and PTSD symptoms. Methods: Contacts with mothers were conducted at the following time points: (a) 6-16 hours after admission to the PICU (Phase I intervention), (b) 16-30 hours following PICU admission, (c) 2-16 hours after transfer from the PICU to the pediatric unit (Phase II intervention), (d) 24-36 hours after transfer to the pediatric unit, (e) 2-3 days after discharge from the hospital (Phase III telephone intervention), and (f) one, three, six, and 12 months after hospital discharge (follow-up contacts). A variety of valid and reliable measures were used to measure the process and outcomes of maternal and child coping. Findings: Mothers in the COPE group, versus mothers in the control group, reported:(a) stronger beliefs regarding their hospitalized children’s responses and their parental role, (b) less stress on the parental stressor scale after transfer to the pediatric unit, (c) less anxiety and negative mood state, including depression, following hospitalization, and (d) fewer PTSD symptoms 12 months following hospitalization. Nurses, blind to study group, also rated the COPE mothers as more involved in their children’s physical and emotional care on the pediatric unit than control mothers. Six and 12-months following discharge from the hospital, children in the COPE group, in comparison to children in the control group, had: (a) fewer behavioral symptoms, (b) fewer externalizing problems, (c) fewer attention problems, (d) less hyperactivity, (e) less aggression, and (f) less depression. At six and 12-months following hospitalization, there was a significantly lower percentage of COPE children (14.3%) with clinically significant behavioral symptoms than control children (22.2%). In addition, only 6.8% of COPE children met the criteria for clinically significant maladaptive behaviors versus 22% of the control group children at the 12-month follow-up. Conclusions: This study provides empirical support for the effectiveness of a reproducible, easy to administer intervention program for mothers of critically ill young children. Future research is needed to determine: (a) the cost-effectiveness of this intervention, (b) whether the positive effects of this intervention program can be sustained for a longer period of time to prevent the subsequent development of disorders that require mental health treatment (e.g., ADHD, chronic PTSD, externalizing disorders), (c) the number of children in the clinically significant range of problems 6- and 12-months following hospitalization who are later diagnosed with ADHD and externalizing disorders, and (d) if the effects of the intervention can be strengthened by father involvement. Implications: Routine implementation of the COPE program throughout the country could prevent maternal and child adverse outcomes as well as costly mental health services.
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